Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

In a paper published in The Lancet medical journal Friday, experts found only a slight difference between the survival rates of HIV patients on AIDS drugs who were monitored with laboratory tests and those who were not. Lab tests can be an early indication of problems in HIV patients that are not yet obvious.

The research was based on computer modeling, and while the results must be verified, they could influence how HIV patients across Africa and Asia are treated.

As drugs to combat AIDS have been distributed in developing countries, some doctors worry that without lab monitoring, patients will either die earlier or develop drug resistance faster. But based on the evidence to date, that has not happened.

“We often get stuck in letting the perfect be the enemy of the good,” said Jennifer Kates, an HIV expert at the Kaiser Family Foundation in Washington. She was not connected to the study.

“Waiting for the perfect lab infrastructure to be ready before rolling out antiretroviral therapy (AIDS drugs) means that millions of people will die,” Kates said. “This study says we shouldn’t wait.”

Andrew Phillips and colleagues from the Royal Free and University College Medical School in London used a computer model that simulated patient details based on HIV progression in real patients. They then projected the patients’ survival for up to 20 years. Data from real patients are not yet available.

Difference in survival very slight
Phillips and his colleagues essentially found that 83 percent of patients who were monitored with lab tests survived five years, compared with 82 percent for those who went without the tests. Over two decades, 67 percent of those who got lab tests survived versus 64 percent for those who did not.

The difference is negligible — and contradicts long-held beliefs that AIDS drugs must be accompanied by regular laboratory monitoring to benefit patients.

Phillips developed the original computer model with funding from Pfizer Inc., makers of many of the drugs used to fight HIV and AIDS.

Some experts worry that because people who are not monitored with lab tests stay longer on drugs that do not work, they could be spreading drug-resistant HIV.

Nathan Ford, head of Medecins Sans Frontieres’ medical unit in South Africa, said there are no signs that drug resistance is developing more quickly in Africa than elsewhere. Ford was not involved in the study.